Towards a qualitative understanding of exercise referral: perceptions and opinions of Exercise Referral

Exercise Referral (ER) is a common mechanism in the UK to increase physical activity levels of ‘sedentary’ individuals and those diagnosed with chronic disease. Despite growth in ER schemes there remains limited evidence of ER’s impact and service provision is inconsistent. Importantly, there is a need to develop a greater understanding of how the meanings associated with ER are produced, reproduced and resisted amongst stakeholders. This paper presents data from interviews conducted with 27 participants in ER services from the east of England (7 exercise professionals, 5 health professionals and 15 clients), analysed through a figurational sociological lens. Interviews explored the meanings stakeholders attached to ER, as well as lived experiences of ER services. Data were analysed using thematic analysis. Four key themes emerged relating to stakeholder expectations, relationships, perceptions of programme delivery and programme receipt. Data highlighted the conflicting and inconsistent nature of stakeholder perceptions within and across groups, suggesting that participants attached specific, interdependent and sometimes contradictory meanings to ER services, and often defined their role and expectations of ER in relation to those of ‘other’ groups. This created conflict, and some participants appeared to reinvent or even resist aspects of what they considered the views and goals of ‘other’ stakeholders. In contrast to health-professional accounts, exercise professionals and clients outlined how they perceived health professionals’ understanding of ER and the benefits of physical activity to be deficient. This resulted in participants from these groups failing to communicate with health professionals under the presumption that they lacked interest. Through understanding power relationships in the ER figuration, it becomes possible to see how intended actions of all stakeholders can interact within ER service delivery, creating interesting, unintended consequences.